<?php
	$date = DateTime::createFromFormat('Y-m-d', $student->dob)->format('F d, Y');
	$bdate = explode(' ',$student->dob);
	$bdate_at = explode('-',$bdate[0]);
	$created = explode(' ',$student->created);
	$created_at = explode('-',$created[0]);
?>

<link rel="stylesheet" href="<?=style_url('formregistration');?>">
<style>
	span.underline{border-bottom:1px solid #000;}
</style>
<div>

	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td valign="top">
				<table style="border:1 solid #8D38C9;" cellPadding="4" cellSpacing="4">
					<tr>
						<td colspan="13">&nbsp;</td>
					</tr>
					<tr>
						<td style="width:100px; text-align:right;">Date of</td>
						<td style="width:12px;">&nbsp;</td>
						<td style="border:1 solid #000; padding:4px; margin:4px; width:12px;"><?php echo substr($created_at[2],0,1); ?></td>
						<td style="border:1 solid #000; padding:4px; margin:4px; width:12px;"><?php echo substr($created_at[2],1,1); ?></td>
						<td style="padding:2px; margin:4px; width:12px;">&nbsp;</td>
						<td style="border:1 solid #000; padding:2px; margin:4px; width:12px;"><?php echo substr($created_at[1],0,1); ?></td>
						<td style="border:1 solid #000; padding:2px; margin:4px; width:12px;"><?php echo substr($created_at[1],1,1); ?></td>
						<td style="padding:2px; margin:4px; width:12px;">&nbsp;</td>
						<td style="border:1 solid #000; padding:2px; margin:4px; width:12px;"><?php echo substr($created_at[0],0,1); ?></td>
						<td style="border:1 solid #000; padding:2px; margin:4px; width:12px;"><?php echo substr($created_at[0],1,1); ?></td>
						<td style="border:1 solid #000; padding:2px; margin:4px; width:12px;"><?php echo substr($created_at[0],2,1); ?></td>
						<td style="border:1 solid #000; padding:2px; margin:4px; width:12px;"><?php echo substr($created_at[0],3,1); ?></td>
						<td style="padding:2px; margin:4px; width:12px;">&nbsp;</td>
					</tr>
					<tr>
						<td style="width:100px; text-align:right;">Application:</td>
						<td>&nbsp;</td>
						<td colspan="2" align="center" style="font-size:14px;">DAY</td>
						<td>&nbsp;</td>
						<td colspan="2" align="center" style="font-size:14px;">MO</td>
						<td>&nbsp;</td>
						<td colspan="4" align="center" style="font-size:14px;">YEAR</td>
						<td>&nbsp;</td>
					</tr>
					<tr>
						<td colspan="13">&nbsp;</td>
					</tr>
				</table>
			</td>
			<td style="width:600px; text-align:center;">
				<!--
				<p style="font-size:20; font-weight:bold;"><?=$school_name;?></p>
				<p style="font-size:12;"><?=$school_address;?></p>
				<p style="font-size:12;"><?=$school_telephone;?></p>
				<p>&nbsp;</p>
				-->
				logo
				<table width="480px" border="0" cellPadding="4" cellSpacing="4">
					<tr>
						<td style="border:1 solid #000; padding:2px; margin:4px; width:12px; text-align:center;"><?php if($student->level_category == 'preschool'){ ?>X<?php }else{ ?> &nbsp;&nbsp; <?php } ?></td><td style="font-size:16px;">PRESCHOOL</td>
						<td style="30">&nbsp;</td>
						<td style="border:1 solid #000; padding:2px; margin:4px; width:12px; text-align:center;"><?php if($student->level_category == 'gradeschool'){ ?>X<?php }else{ ?> &nbsp;&nbsp; <?php } ?></td><td style="font-size:16px;">GRADE SCHOOL</td>
						<td style="30">&nbsp;</td>
						<td style="border:1 solid #000; padding:2px; margin:4px; width:12px; text-align:center;"><?php if($student->level_category == 'highschool'){ ?>X<?php }else{ ?> &nbsp;&nbsp; <?php } ?></td><td style="font-size:16px;">HIGH SCHOOL</td>
					</tr>
				</table>
			</td>
			<td class="id_picture">
				PHOTO
			</td>
		</tr>
	</table>

</div>
<div style="padding-top:5px;">
	<table cellPadding="0" cellSpacing="0" style="margin:0px; padding:0px; border-collapse:collapse;">
		<tr style="background-color:#8D38C9; margin:0px; padding:0px;">
			<td colspan="4" style="color:#FFFF00; font-size:16; padding:4; margin:0px;"><span style="font-weight:bold;">APPLICANT INFORMATION</span> (List all names as recorded in birth certificate/passport)</td>
		</tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; border-bottom:1px solid #8D38C9;">
			<table border="0" cellPadding="0" cellSpacing="0">
				<tr>
					<td colspan="4" style="font-size:14px; padding-left:4px;">Name of Child</td>
				</tr>
				<tr>
					<td style="font-size:14px; padding-left:4px; text-align:center; text-transform:capitalize;"><?=ucfirst($student->lastname);?></td>
					<td style="font-size:14px; padding-left:4px; text-align:center; text-transform:capitalize;"><?=ucfirst($student->firstname);?></td>
					<td style="font-size:14px; padding-left:4px; text-align:center; text-transform:capitalize;"><?=ucfirst($student->middlename);?></td>
				</tr>
				<tr>
					<td style="font-size:14px; padding-left:4px; text-align:center; width:200px;">LAST NAME</td>
					<td style="font-size:14px; padding-left:4px; text-align:center; width:200px;">FIRST NAME</td>
					<td style="font-size:14px; padding-left:4px; text-align:center; width:200px;">MIDDLE NAME</td>
				</tr>
			</table>
		</td><td valign="bottom" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9;">
			<table border="0" cellPadding="0" cellSpacing="0">
				<tr>
					<td>&nbsp;</td>
				</tr>
				<tr>
					<td style="font-size:14px; padding-left:4px; text-align:center; text-transform:capitalize;">
					
					<span><?=ucfirst($student->nickname);?></span>
					
					</td>
				</tr>
				<tr>
					<td style="font-size:14px; padding-left:4px; text-align:center; width:200px;">PREFERRED NAME</td>
				</tr>
			</table>
		</td><td style="border-bottom:1px solid #8D38C9; border-right:1px solid #8D38C9;">
			<table border="0" cellPadding="0" cellSpacing="0">
				<tr>
					<td colspan="3" style="width:100px;">&nbsp;</td>
				</tr>
				<tr>
					<td style="font-size:14px; padding-left:4px;">Gender</td>
					<td style="text-align:center;"><?php if($student->gender == 'male'){ ?><table border="0" cellPadding="0" cellSpacing="0"><tr><td style="border:1 solid #000; width:14px; text-align:center;">X</td></tr></table> <?php }else{ ?> <table border="0" cellPadding="0" cellSpacing="0"><tr><td style="border:1 solid #000; width:14px; text-align:center;">&nbsp;&nbsp;</td></tr></table> <?php } ?></td>
					<td style="text-align:center;"><?php if($student->gender == 'female'){ ?><table border="0" cellPadding="0" cellSpacing="0"><tr><td style="border:1 solid #000; width:14px; text-align:center;">X</td></tr></table> <?php }else{ ?> <table border="0" cellPadding="0" cellSpacing="0"><tr><td style="border:1 solid #000; width:14px; text-align:center;">&nbsp;&nbsp;</td></tr></table> <?php } ?></td>
				</tr>
				<tr>
					<td style="font-size:14px; padding-left:4px;">&nbsp;</td>
					<td style="text-align:center; font-size:14px; padding-left:4px;">Male</td>
					<td style="text-align:center; font-size:14px; padding-left:4px;">Female</td>
				</tr>
			</table>
		</td></tr>
		<tr><td style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; border-left:1px solid #8D38C9;">
			<table border="0" cellPadding="0" cellSpacing="0">
			<tr>
			<td colspan="2" valign="top" style="font-size:14px; padding-left:4px;">Date of Birth:</td>
			<td>
				<table border="0" cellPadding="4" cellSpacing="4">
					<tr>
						<td style="width:12px;">&nbsp;</td>
						<td style="border:1 solid #000; padding:2px 4px; margin:4px; width:12px;"><?php echo substr($bdate_at[2],0,1); ?></td>
						<td style="border:1 solid #000; padding:2px 4px; margin:4px; width:12px;"><?php echo substr($bdate_at[2],1,1); ?></td>
						<td style="width:12px;">&nbsp;</td>
						<td style="border:1 solid #000; padding:2px 4px; margin:4px; width:12px;"><?php echo substr($bdate_at[1],0,1); ?></td>
						<td style="border:1 solid #000; padding:2px 4px; margin:4px; width:12px;"><?php echo substr($bdate_at[1],1,1); ?></td>
						<td style="width:12px;">&nbsp;</td>
						<td style="border:1 solid #000; padding:2px 4px; margin:4px; width:12px;"><?php echo substr($bdate_at[0],0,1); ?></td>
						<td style="border:1 solid #000; padding:2px 4px; margin:4px; width:12px;"><?php echo substr($bdate_at[0],1,1); ?></td>
						<td style="border:1 solid #000; padding:2px 4px; margin:4px; width:12px;"><?php echo substr($bdate_at[0],2,1); ?></td>
						<td style="border:1 solid #000; padding:2px 4px; margin:4px; width:12px;"><?php echo substr($bdate_at[0],3,1); ?></td>
						<td style="width:12px;">&nbsp;</td>
					</tr>
					<tr>
						<td>&nbsp;</td>
						<td colspan="2" align="center" style="font-size:14px;">DAY</td>
						<td>&nbsp;</td>
						<td colspan="2" align="center" style="font-size:14px;">MO</td>
						<td>&nbsp;</td>
						<td colspan="4" align="center" style="font-size:14px;">YEAR</td>
						<td>&nbsp;</td>
					</tr>
				</table>
			</td>
			</tr>
			</table>
		</td><td valign="top" style="width:300px; border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; height:38px;">
			<table border="0" cellPadding="4" cellSpacing="4">
				<tr>
					<td style="font-size:14px;">Citizenship</td><td rowspan="2" valign="top"><?=$student->nationality;?></td>
				</tr>
				<tr>
					<td style="font-size:14px;">(Passport)</td>
				</tr>
			</table>
		</td><td  valign="top" colspan="2" style="border-bottom:1px solid #8D38C9; border-right:1px solid #8D38C9; height:38px;">
			<table border="0" cellPadding="4" cellSpacing="4" height="100%">
				<tr>
					<td valign="top" style="font-size:14px;">Place of Birth:&nbsp;&nbsp;<?=$student->pob;?></td>
				</tr>
			</table>
		</td></tr>
		<tr><td valign="top" colspan="4" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; height:38px; border-left:1px solid #8D38C9;">
			<table border="0" cellPadding="4" cellSpacing="4">
				<tr>
					<td valign="top" style="font-size:14px;">Residential Address in the Philippines&nbsp;&nbsp;<?=$student->present_address;?></td>
				</tr>
			</table>
		</td></tr>
		<tr><td valign="top" style="border-left:1px solid #8D38C9; border-bottom:1px solid #8D38C9; border-right:1px solid #8D38C9; height:38px;">
			<table border="0" cellPadding="4" cellSpacing="4">
				<tr>
					<td valign="top" style="font-size:14px;">Home Phone:&nbsp;&nbsp;<?=$student->contact_no;?></td>
				</tr>
			</table>
		</td><td valign="top" style="border-bottom:1px solid #8D38C9; border-right:1px solid #8D38C9; height:38px;">
			<table border="0" cellPadding="4" cellSpacing="4">
				<tr>
					<td valign="top" style="font-size:14px;">Mobile Phone:&nbsp;&nbsp;<?=$student->mobile_phone;?></td>
				</tr>
			</table>
		</td><td valign="top" colspan="2" style="border-bottom:1px solid #8D38C9; border-right:1px solid #8D38C9;">
			<table border="0" cellPadding="4" cellSpacing="4">
				<tr>
					<td valign="top" style="font-size:14px; height:38px;">Religion:&nbsp;&nbsp;<?=$student->religion;?></td>
				</tr>
			</table>
		</td></tr>
	</table>
	
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td>1- The student will be living in the Philippines with (pls. check all that apply):</td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td style="width:100px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->living_in_ph_with_father == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;Father/Step-Father</td><td style="width:50px;"><td style="width:14px; border:1 solid #000;"><?php if($student->living_in_ph_with_mother == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;Mother/Step-Mother</td><td style="width:50px;">&nbsp;</td><td>&nbsp;</td><td>&nbsp;</td><td>&nbsp;</td>
		</tr>
		<!--
		<tr>
			<td style="width:100px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->living_in_ph_with_step_father == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;Step-Father</td><td style="width:50px;"><td style="width:14px; border:1 solid #000;"><?php if($student->living_in_ph_with_step_mother == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;Step-Mother</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->living_in_ph_with_guardian == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;Legal Guardian:</td><td style="border-bottom:#000 1px solid; width:280px;"><?php echo $student->living_in_ph_with_legal_guardian_name; ?></td><td style="width:50px;">&nbsp;</td><td style="border-bottom:#000 1px solid; width:130px;"><?php echo $student->living_in_ph_with_legal_guardian_contact_number; ?></td>
		</tr>
		<tr>
			<td>&nbsp;</td><td>&nbsp;</td><td>&nbsp;</td><td>&nbsp;</td><td>&nbsp;</td><td>&nbsp;</td><td>&nbsp;</td><td>&nbsp;</td><td>&nbsp;</td><td style="text-align:center;">Name</td><td style="width:50px;">&nbsp;</td><td style="text-align:center;">Contact Number</td>
		</tr>
		-->
		<tr>
			<td style="width:100px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->living_in_ph_with_guardian == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;Legal Guardian</td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td>2- Your child's English reading and writing level: </td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->childs_english_reading_writing_level == 'good'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;good</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->childs_english_reading_writing_level == 'fair'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;fair</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->childs_english_reading_writing_level == 'limited'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;limited</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->childs_english_reading_writing_level == 'none'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;none</td><td style="width:300px;">&nbsp;</td>
		</tr>
		<tr>
			<td>3- Your child's English verbal proficiency: </td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->childs_english_verbal_proficiency == 'good'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;good</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->childs_english_verbal_proficiency == 'fair'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;fair</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->childs_english_verbal_proficiency == 'limited'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;limited</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->childs_english_verbal_proficiency == 'none'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;none</td><td style="width:300px;">&nbsp;</td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td style="width:180px;">4- Languages Spoken at home? </td><td style="border-bottom:1 solid #000;"><?=$student->language_at_home;?></td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td>5- List any participation in advanced level classes (i.e., Advanced Math, Gifted or Talented, Gateway, Writing, etc.) </td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td style="width:15px">&nbsp;</td><td style="border-bottom:1 solid #000;">&nbsp;<?=$student->participation_in_advanced_level_classes;?></td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td>6- Did your child receive any remedial help in previous schools (i.e., Remedial Program, Special Education, Speech Therapy, IEP, IDP, etc). If yes, please explain and provide latest testing results.</td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td style="width:15px">&nbsp;</td><td style="border-bottom:1 solid #000;">&nbsp;<?=$student->remedial_help_in_previous_schools;?></td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td valign="top">7- Does your child have any special talent or interest in:</td><td valign="top">
				<table cellPadding="0" cellSpacing="2">
					<tr>
						<td>
							<table cellPadding="0" cellSpacing="2">
								<tr>
									<td style="width:14px; border:1 solid #000;"><?php if($student->special_talent_interest_dance == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;Dance</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->special_talent_interest_drama == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;Drama</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->special_talent_interest_art == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;Art</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->special_talent_interest_acomputer == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;Computer</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->special_talent_interest_vocal_chorus == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;Vocal or Chorus</td><td style="width:100px;">&nbsp;</td>
								</tr>
							</table>
						</td>
					</tr>
					<tr>
						<td>
							<table cellPadding="0" cellSpacing="2">
								<tr>
									<td style="width:14px; border:1 solid #000;"><?php if($student->special_talent_interest_athletics == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;Athletics - favorite sport(s):</td><td style="border-bottom:1 solid #000; min-width:200px;">&nbsp;<?=$student->special_talent_interest_athletics_spec;?></td>
								</tr>
							</table>
						</td>
					</tr>
					<tr>
						<td>
							<table cellPadding="0" cellSpacing="2">
								<tr>
									<td style="width:14px; border:1 solid #000;"><?php if($student->special_talent_interest_band == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;Band (Instrument?)</td><td style="border-bottom:1 solid #000; width:200px;">&nbsp;<?=$student->special_talent_interest_band_spec;?></td><td>&nbsp;</td><td style="width:14px; border:1 solid #000;"><?php if($student->special_talent_interest_string == 'yes'){ ?><span>&nbsp;X&nbsp;</span> <?php }else{ ?> <span>&nbsp;&nbsp;&nbsp;&nbsp;</span> <?php } ?></td><td>&nbsp;String (Instrument?)</td><td style="border-bottom:1 solid #000; width:200px;">&nbsp;<?=$student->special_talent_interest_string_spec;?></td>
								</tr>
							</table>
						</td>
					</tr>
				</table>
			</td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td>8- Is there any other information you think the teacher should know about your child? </td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td style="width:15px">&nbsp;</td><td style="border-bottom:1 solid #000;">&nbsp;<?=$student->dhc_hinder_learning_process;?></td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td>9- Has your child ever been asked to leave school because of any behavioral / disciplinary problems? If yes, please explain. </td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2" style="page-break-after:always;">
		<tr>
			<td style="width:15px">&nbsp;</td><td style="border-bottom:1 solid #000;">&nbsp;<?=$student->leave_school;?></td>
		</tr>
	</table>
</div>

<div>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td>**<span style="font-weight:bold;">REQUIRED INFORMATION:</span> Provide (print) the <span style="font-weight:bold; font-style:italic;">complete</span> name and address of your child's most recent school. WIS reserves the right to contact the previous Head of School directly for further information on your child's school documents / records.</td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td style="font-style:italic; width:153px;"><span style="font-weight:bold;">Name of Previous School:</span></td>
			<td style="border-bottom:1 solid #000; min-width:200px;">&nbsp;<?=$student->previous_school;?></td>
			<td>&nbsp;</td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td style="font-style:italic; width:220px;"><span style="font-weight:bold;">Complete Address</span> (including zip code):</td>
			<td style="border-bottom:1 solid #000; min-width:200px;">&nbsp;<?=$student->previous_school_address;?></td><td>&nbsp;</td>
		</tr>
	</table>
	<table cellPadding="0" cellSpacing="2">
		<tr>
			<td style="font-style:italic; width:180px;"><span style="font-weight:bold;">Grade Level / Academic Year:</td>
			<td style="border-bottom:1 solid #000; min-width:240px;">&nbsp;<?=$student->previous_grade_level;?></td><td>&nbsp;</td>
		</tr>
	</table>
</div>
<!--
<div style="padding-top:5px;">
	<table cellPadding="0" cellSpacing="0" style="border:1px solid #8D38C9; margin:0px; padding:0px; border-collapse:collapse;">
		<tr style="background-color:#8D38C9; margin:0px; padding:0px;">
			<td style="color:#FFFF00; font-size:16; padding:4; margin:0px; text-align:center; font-weight:bold; width:150px;">GRADE / LEVEL</td>
			<td style="color:#FFFF00; font-size:16; padding:4; margin:0px; text-align:center; font-weight:bold;">NAME OF SCHOOL</td>
			<td style="color:#FFFF00; font-size:16; padding:4; margin:0px; text-align:center; font-weight:bold; width:250px;">ACADEMIC YEAR ATTENDED</td>
		</tr>
		<tr><td style="border-bottom:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:4; margin:0px;">
			&nbsp;<?=$student->previous_school_grade_1;?>
		</td><td style="border-bottom:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:4; margin:0px;">
			&nbsp;<?=$student->previous_school_name_1;?>
		</td><td style="border-bottom:1px solid #8D38C9; padding:4; margin:0px;">
			&nbsp;<?=$student->previous_school_year_1;?>
		</td></tr>
		<tr><td style="border-bottom:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:4; margin:0px;">
			&nbsp;<?=$student->previous_school_grade_2;?>
		</td><td style="border-bottom:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:4; margin:0px;">
			&nbsp;<?=$student->previous_school_grade_2;?>
		</td><td style="border-bottom:1px solid #8D38C9; padding:4; margin:0px;">
			&nbsp;<?=$student->previous_school_grade_2;?>
		</td></tr>
		<tr><td style="border-bottom:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:4; margin:0px;">
			&nbsp;<?=$student->previous_school_grade_3;?>
		</td><td style="border-bottom:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:4; margin:0px;">
			&nbsp;<?=$student->previous_school_grade_3;?>
		</td><td style="border-bottom:1px solid #8D38C9; padding:4; margin:0px;">
			&nbsp;<?=$student->previous_school_grade_3;?>
		</td></tr>
	</table>
</div>
-->
<!--
<div>
	<table cellPadding="0" cellSpacing="0"><tr><td>&nbsp;</td></tr></table>
	<table cellPadding="0" cellSpacing="0" style="margin:0px; padding:0px; border-collapse:collapse; page-break-inside:avoid;">
		<tr style="background-color:#8D38C9; margin:0px; padding:0px;">
			<td colspan="4" style="color:#FFFF00; font-size:16; padding:4; margin:0px; font-weight:bold;">PARENT / LEGAL GUARDIAN INFORMATION</td>
		</tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->fathername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000; text-align:center;">X</td><td style="font-size:14px;">Father</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Step-father</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Legal Guardian</td></tr></table>
		<?php }elseif($student->step_father_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Father</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;">X</td><td style="font-size:14px;">Step-father</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;">&nbsp;</td><td style="font-size:14px;">Legal Guardian</td></tr></table>
		<?php }elseif($student->guardian_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Father</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Step-father</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;">X</td><td style="font-size:14px;">Legal Guardian</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Father</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Step-father</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Legal Guardian</td></tr></table>
		<?php } ?>
		</td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->mothername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000; text-align:center;">X</td><td style="font-size:14px;">Mother</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Step-mother</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Legal Guardian</td></tr></table>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Mother</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;">X</td><td style="font-size:14px;">Step-mother</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Legal Guardian</td></tr></table>
		<?php }elseif($student->guardian_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Mother</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Step-mother</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Legal Guardian</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Mother</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Step-mother</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Legal Guardian</td></tr></table>
		<?php } ?>
		</td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->fathername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;<?=$student->father_lname;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_father_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;<?=$student->step_father_lname;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }elseif($student->guardian_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;<?=$student->guardian_lname;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;</td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->mothername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;<?=$student->mother_lname;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;<?=$student->step_mother_lname;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }elseif($student->guardian_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;</td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;</td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->fathername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;<?=$student->fathername;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_father_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;<?=$student->step_father_name;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }elseif($student->guardian_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;<?=$student->guardian_name;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;</td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->mothername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;<?=$student->mothername;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;<?=$student->step_mother_name;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }elseif($student->guardian_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;</td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;</td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->fathername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:390px;">&nbsp;<?=$student->father_mname;?></td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_father_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:390px;">&nbsp;<?=$student->step_father_mname;?></td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php }elseif($student->guardian_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:390px;">&nbsp;<?=$student->guardian_mname;?></td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:390px;">&nbsp;</td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->mothername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:390px;">&nbsp;<?=$student->mother_mname;?></td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:390px;">&nbsp;<?=$student->step_mother_mname;?></td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php }elseif($student->guardian_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:390px;">&nbsp;</td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:390px;">&nbsp;</td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; padding:2px 4px; margin:0px;">&nbsp;</td><td colspan="2" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; padding:2px 4px; margin:0px;">&nbsp;</td></tr>
		<tr><td style="width:25%; border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; border-left:1px solid #8D38C9; padding:0px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px;">Citizenship&nbsp;</td><td rowspan="2" valign="top">
		<?php if($student->fathername!=''){ ?>
		<?=$student->father_nationality;?>
		<?php }elseif($student->step_father_name!=''){ ?>
		<?=$student->step_father_citizenship;?>
		<?php }elseif($student->guardian_name!=''){ ?>
		<?=$student->guardian_citizenship;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</td></tr><tr><td style="font-size:14px;">(Passport)&nbsp;</td></tr></table></td><td style="width:25%; padding:0px 4px; margin:0px; border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px;">Philippine&nbsp;</td><td rowspan="2" valign="top">
		<?php if($student->fathername!=''){ ?>
		<?=$student->father_visa;?>
		<?php }elseif($student->step_father_name!=''){ ?>
		<?=$student->step_father_visa;?>
		<?php }elseif($student->guardian_name!=''){ ?>
		<?=$student->guardian_visa;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</td></tr><tr><td style="font-size:14px;">Visa Status&nbsp;</td></tr></table></td><td style="width:25%; border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; padding:0px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px;">Citizenship&nbsp;</td><td rowspan="2" valign="top">
		<?php if($student->mothername!=''){ ?>
		<?=$student->mother_nationality;?>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<?=$student->step_mother_citizenship;?>
		<?php }elseif($student->guardian_name!=''){ ?>
		&nbsp;
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</td></tr><tr><td style="font-size:14px;">(Passport)&nbsp;</td></tr></table></td><td style="width:25%; padding:0px 4px; margin:0px; border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px;">Philippine&nbsp;</td><td rowspan="2" valign="top">
		<?php if($student->mothername!=''){ ?>
		<?=$student->mother_visa;?>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<?=$student->step_mother_visa;?>
		<?php }elseif($student->guardian_name!=''){ ?>
		&nbsp;
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</td></tr><tr><td style="font-size:14px;">Visa Status&nbsp;</td></tr></table></td></tr>
		<tr><td colspan="2" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; border-left:1px solid #8D38C9; padding:0px 4px; margin:0px; height:38px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px;">Employer or&nbsp;</td><td rowspan="2" valign="top">
		<?php if($student->fathername!=''){ ?>
		<?=$student->father_occupation;?>
		<?php }elseif($student->step_father_name!=''){ ?>
		<?=$student->step_father_occup;?>
		<?php }elseif($student->guardian_name!=''){ ?>
		<?=$student->guardian_occup;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</td></tr><tr><td style="font-size:14px;">Organization:&nbsp;</td></tr></table></td><td colspan="2" style="border-right:1px solid #8D38C9;  border-bottom:1px solid #8D38C9; padding:0px 4px; margin:0px; height:38px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px;">Employer or&nbsp;</td><td rowspan="2" valign="top">
		<?php if($student->mothername!=''){ ?>
		<?=$student->mother_occupation;?>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<?=$student->step_mother_occup;?>
		<?php }elseif($student->guardian_name!=''){ ?>
		&nbsp;
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</td></tr><tr><td style="font-size:14px;">Organization:&nbsp;</td></tr></table></td></tr>
		<tr><td colspan="2" valign="top" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; border-left:1px solid #8D38C9; font-size:14px; padding:0px 4px; margin:0px; height:38px;">Office Phone Number:&nbsp;<span style="font-size:12px;">
		<?php if($student->fathername!=''){ ?>
		<?=$student->father_office_num;?>
		<?php }elseif($student->step_father_name!=''){ ?>
		<?=$student->step_father_office_tel;?>
		<?php }elseif($student->guardian_name!=''){ ?>
		<?=$student->guardian_office_tel;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</span></td><td colspan="2" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; font-size:14px; padding:0px 4px; margin:0px; height:38px;" valign="top">Office Phone Number:&nbsp;<span style="font-size:12px;"><?php if($student->mothername!=''){ ?>
		<?=$student->mother_office_num;?>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<?=$student->step_mother_office_tel;?>
		<?php }elseif($student->guardian_name!=''){ ?>
		&nbsp;
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</span></td></tr>
		
		<tr><td colspan="2" valign="top" style="border-right:1px solid #8D38C9; border-left:1px solid #8D38C9; font-size:14px; padding:0px 4px; margin:0px;">Mobile Number:&nbsp;<span style="font-size:12px;">
		<?php if($student->fathername!=''){ ?>
		<?=$student->father_contact_no;?>
		<?php }elseif($student->step_father_name!=''){ ?>
		<?=$student->step_father_contact_no;?>
		<?php }elseif($student->guardian_name!=''){ ?>
		<?=$student->guardian_contact_no;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</span></td><td colspan="2" style="border-right:1px solid #8D38C9; font-size:14px; padding:0px 4px; margin:0px;" valign="top">Mobile Number:&nbsp;<span style="font-size:12px;">
		<?php if($student->mothername!=''){ ?>
		<?=$student->mother_contact_no;?>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<?=$student->step_mother_contact_no;?>
		<?php }elseif($student->guardian_name!=''){ ?>
		&nbsp;
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</span></td></tr>

		<tr><td colspan="2" valign="top" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; border-left:1px solid #8D38C9; font-size:12px; padding:0px 4px; margin:0px;">Would you like to receive text messages about upcoming events, activities and other school announcements on this number?&nbsp;&nbsp;&nbsp;(
		<?php if($student->fathername!=''){ ?>
			<?php if($student->father_contact_no_text=='yes'){ echo '<span style="text-decoration:underline;">Yes</span>'; }else{ echo 'Yes'; } ?>
		<?php }elseif($student->step_father_name!=''){ ?>
			<?php if($student->step_father_contact_no_text=='yes'){ echo '<span style="text-decoration:underline;">Yes</span>'; }else{ echo 'Yes'; } ?>
		<?php }elseif($student->guardian_name!=''){ ?>
			<?php if($student->guardian_contact_no_text=='yes'){ echo '<span style="text-decoration:underline;">Yes</span>'; }else{ echo 'Yes'; } ?>
		<?php }else{ ?>
		Yes
		<?php } ?>
		&nbsp;or&nbsp; 
		<?php if($student->fathername!=''){ ?>
			<?php if($student->father_contact_no_text=='no' || $student->father_contact_no_text==''){ echo '<span style="text-decoration:underline;">No</span>'; }else{ echo 'No'; } ?>
		<?php }elseif($student->step_father_name!=''){ ?>
			<?php if($student->step_father_contact_no_text=='no' || $student->step_father_contact_no_text==''){ echo '<span style="text-decoration:underline;">No</span>'; }else{ echo 'No'; } ?>
		<?php }elseif($student->guardian_name!=''){ ?>
			<?php if($student->guardian_contact_no_text=='no' || $student->guardian_contact_no_text==''){ echo '<span style="text-decoration:underline;">No</span>'; }else{ echo 'No'; } ?>
		<?php }else{ ?>
		No
		<?php } ?>
		)</td><td colspan="2" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; font-size:12px; padding:0px 4px; margin:0px;" valign="top">Would you like to receive text messages about upcoming events, activities and other school announcements on this number?&nbsp;&nbsp;&nbsp;(
		
		<?php if($student->mothername!=''){ ?>
			<?php if($student->mother_contact_no_text=='yes'){ echo '<span style="text-decoration:underline;">Yes</span>'; }else{ echo 'Yes'; } ?>
		<?php }elseif($student->step_mother_name!=''){ ?>
			<?php if($student->step_mother_contact_no_text=='yes'){ echo '<span style="text-decoration:underline;">Yes</span>'; }else{ echo 'Yes'; } ?>
		<?php }elseif($student->guardian_name!=''){ ?>
		Yes
		<?php }else{ ?>
		Yes
		<?php } ?>

		&nbsp;or&nbsp;
		
		<?php if($student->mothername!=''){ ?>
			<?php if($student->mother_contact_no_text=='no' || $student->mother_contact_no_text==''){ echo '<span style="text-decoration:underline;">No</span>'; }else{ echo 'No'; } ?>
		<?php }elseif($student->step_mother_name!=''){ ?>
			<?php if($student->step_mother_contact_no_text=='no' || $student->step_mother_contact_no_text==''){ echo '<span style="text-decoration:underline;">No</span>'; }else{ echo 'No'; } ?>
		<?php }elseif($student->guardian_name!=''){ ?>
		No
		<?php }else{ ?>
		No
		<?php } ?>
		
		)</td></tr>

		<tr><td colspan="4" style="border-right:1px solid #8D38C9; border-left:1px solid #8D38C9; padding:4px 4px 2px 4px; margin:0px; font-weight:bold; font-size:16px;">EMERGENCY CONTACT INFORMATION</td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:425px;">&nbsp;<?=$student->emergency_name;?></td><td style="width:30px;">&nbsp;</td></tr></table></td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">&nbsp;&nbsp;&nbsp;Address:</td><td style="font-size:12px; border-bottom:1px solid #000; width:410px;">&nbsp;<?=$student->emergency_address;?></td><td style="width:30px;">&nbsp;</td></tr></table></td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Office Phone:</td><td style="font-size:12px; border-bottom:1px solid #000; width:385px;">&nbsp;<?=$student->emergency_office_tel;?></td><td style="width:30px;">&nbsp;</td></tr></table></td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">&nbsp;&nbsp;&nbsp;Home Phone:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;<?=$student->emergency_home_tel;?></td><td style="width:30px;">&nbsp;</td></tr></table></td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table><tr><td style="font-size:14px;">Mobile No.:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;<?=$student->emergency_home_no;?></td><td style="width:30px;">&nbsp;</td></tr></table></td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">&nbsp;</td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; border-bottom:1px solid #8D38C9; padding:2px 4px; margin:0px;">&nbsp;</td><td colspan="2" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; padding:2px 4px; margin:0px;">&nbsp;</td></tr>
		<tr><td colspan="4" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:0px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td valign="top" ><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="width:14px; border:1 solid #000; text-align:center;">X</td></tr></table></td><td valign="top"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:13px;">Failure to provide complete and accurate information of any kind on this form will void the application and may result to its cancellation. <span style="font-size:14px;">WESTFIELDS INTERNATIONAL SCHOOL</span> reserves the right to determine the placement of the application in the grade level or subjects deemed most appropriate fo the student's school experience / performance.</td></tr></table></td></tr></table></td></tr>
		<tr><td colspan="4" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td valign="top"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td align="top" style="width:14px; border:1 solid #000; text-align:center;">X</td></tr></table></td><td valign="top" ><table style="font-size:13px;"><tr><td style="font-size:13px;">To the best of my knowledge the information written on this form is true and correct.</td></td></table></td></tr></table></td></tr>
		<tr><td colspan="4" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">&nbsp;</td></tr>
		<tr><td colspan="4" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px; text-align:center; width:300px; border-top:#000 1px solid;">Signature of Father</td><td style="width:30px;">&nbsp;</td><td style="font-size:14px; text-align:center; text-align:center; width:300px; border-top:#000 1px solid;">Signature of Mother</td><td style="width:30px;">&nbsp;</td><td style="font-size:14px; text-align:center; text-align:center; width:250px; border-top:#000 1px solid;">Date</td><td style="width:30px;">&nbsp;</td></tr></table></td></tr>
	</table>
</div>
-->

<div>
	<table cellPadding="0" cellSpacing="0"><tr><td>&nbsp;</td></tr></table>
	<table cellPadding="0" cellSpacing="0" style="margin:0px; padding:0px; border-collapse:collapse; page-break-inside:avoid;">
		<tr style="background-color:#8D38C9; margin:0px; padding:0px;">
			<td colspan="4" style="color:#FFFF00; font-size:16; padding:4; margin:0px; font-weight:bold;">PARENT / LEGAL GUARDIAN INFORMATION</td>
		</tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->fathername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000; text-align:center;">X</td><td style="font-size:14px;">Father</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Step-father</td><td style="width:80px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_father_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Father</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;">X</td><td style="font-size:14px;">Step-father</td><td style="width:80px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Father</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Step-father</td><td style="width:80px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->mothername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000; text-align:center;">X</td><td style="font-size:14px;">Mother</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Step-mother</td><td style="width:80px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Mother</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;">X</td><td style="font-size:14px;">Step-mother</td><td style="width:80px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Mother</td><td style="width:80px;">&nbsp;</td><td style="width:14px; border:1 solid #000;">&nbsp;</td><td style="font-size:14px;">Step-mother</td><td style="width:80px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->fathername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;<?=$student->father_lname;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_father_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;<?=$student->step_father_lname;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;</td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->mothername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;<?=$student->mother_lname;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;<?=$student->step_mother_lname;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Last Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;</td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->fathername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;<?=$student->fathername;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_father_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;<?=$student->step_father_name;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;</td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->mothername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;<?=$student->mothername;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;<?=$student->step_mother_name;?></td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">First Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;</td><td style="width:30px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->fathername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:360px;">&nbsp;<?=$student->father_mname;?></td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_father_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:360px;">&nbsp;<?=$student->step_father_mname;?></td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:360px;">&nbsp;</td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">
		<?php if($student->mothername!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:360px;">&nbsp;<?=$student->mother_mname;?></td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:360px;">&nbsp;<?=$student->step_mother_mname;?></td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php }else{ ?>
		<table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Middle Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:360px;">&nbsp;</td><td style="width:40px;">&nbsp;</td></tr></table>
		<?php } ?>
		</td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; padding:2px 4px; margin:0px;">&nbsp;</td><td colspan="2" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; padding:2px 4px; margin:0px;">&nbsp;</td></tr>
		<tr><td style="width:25%; border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; border-left:1px solid #8D38C9; padding:0px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px;">Citizenship&nbsp;</td><td rowspan="2" valign="top">
		<?php if($student->fathername!=''){ ?>
		<?=$student->father_nationality;?>
		<?php }elseif($student->step_father_name!=''){ ?>
		<?=$student->step_father_citizenship;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</td></tr><tr><td style="font-size:14px;">(Passport)&nbsp;</td></tr></table></td><td style="width:25%; padding:0px 4px; margin:0px; border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px;">Philippine&nbsp;</td><td rowspan="2" valign="top">
		<?php if($student->fathername!=''){ ?>
		<?=$student->father_visa;?>
		<?php }elseif($student->step_father_name!=''){ ?>
		<?=$student->step_father_visa;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</td></tr><tr><td style="font-size:14px;">Visa Status&nbsp;</td></tr></table></td><td style="width:25%; border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; padding:0px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px;">Citizenship&nbsp;</td><td rowspan="2" valign="top">
		<?php if($student->mothername!=''){ ?>
		<?=$student->mother_nationality;?>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<?=$student->step_mother_citizenship;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</td></tr><tr><td style="font-size:14px;">(Passport)&nbsp;</td></tr></table></td><td style="width:25%; padding:0px 4px; margin:0px; border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px;">Philippine&nbsp;</td><td rowspan="2" valign="top">
		<?php if($student->mothername!=''){ ?>
		<?=$student->mother_visa;?>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<?=$student->step_mother_visa;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</td></tr><tr><td style="font-size:14px;">Visa Status&nbsp;</td></tr></table></td></tr>
		<tr><td colspan="2" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; border-left:1px solid #8D38C9; padding:0px 4px; margin:0px; height:38px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px;">Employer or&nbsp;</td><td rowspan="2" valign="top">
		<?php if($student->fathername!=''){ ?>
		<?=$student->father_occupation;?>
		<?php }elseif($student->step_father_name!=''){ ?>
		<?=$student->step_father_occup;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</td></tr><tr><td style="font-size:14px;">Organization:&nbsp;</td></tr></table></td><td colspan="2" style="border-right:1px solid #8D38C9;  border-bottom:1px solid #8D38C9; padding:0px 4px; margin:0px; height:38px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px;">Employer or&nbsp;</td><td rowspan="2" valign="top">
		<?php if($student->mothername!=''){ ?>
		<?=$student->mother_occupation;?>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<?=$student->step_mother_occup;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</td></tr><tr><td style="font-size:14px;">Organization:&nbsp;</td></tr></table></td></tr>
		<tr><td colspan="2" valign="top" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; border-left:1px solid #8D38C9; font-size:14px; padding:0px 4px; margin:0px; height:38px;">Office Phone Number:&nbsp;<span style="font-size:12px;">
		<?php if($student->fathername!=''){ ?>
		<?=$student->father_office_num;?>
		<?php }elseif($student->step_father_name!=''){ ?>
		<?=$student->step_father_office_tel;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</span></td><td colspan="2" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; font-size:14px; padding:0px 4px; margin:0px; height:38px;" valign="top">Office Phone Number:&nbsp;<span style="font-size:12px;"><?php if($student->mothername!=''){ ?>
		<?=$student->mother_office_num;?>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<?=$student->step_mother_office_tel;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</span></td></tr>
		
		<tr><td colspan="2" valign="top" style="border-right:1px solid #8D38C9; border-left:1px solid #8D38C9; font-size:14px; padding:0px 4px; margin:0px;">Mobile Number:&nbsp;<span style="font-size:12px;">
		<?php if($student->fathername!=''){ ?>
		<?=$student->father_contact_no;?>
		<?php }elseif($student->step_father_name!=''){ ?>
		<?=$student->step_father_contact_no;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</span></td><td colspan="2" style="border-right:1px solid #8D38C9; font-size:14px; padding:0px 4px; margin:0px;" valign="top">Mobile Number:&nbsp;<span style="font-size:12px;">
		<?php if($student->mothername!=''){ ?>
		<?=$student->mother_contact_no;?>
		<?php }elseif($student->step_mother_name!=''){ ?>
		<?=$student->step_mother_contact_no;?>
		<?php }else{ ?>
		&nbsp;
		<?php } ?>
		</span></td></tr>

		<tr><td colspan="2" valign="top" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; border-left:1px solid #8D38C9; font-size:12px; padding:0px 4px; margin:0px;">Would you like to receive text messages about upcoming events, activities and other school announcements on this number?&nbsp;&nbsp;&nbsp;(
		<?php if($student->fathername!=''){ ?>
			<?php if($student->father_contact_no_text=='yes'){ echo '<span style="text-decoration:underline;">Yes</span>'; }else{ echo 'Yes'; } ?>
		<?php }elseif($student->step_father_name!=''){ ?>
			<?php if($student->step_father_contact_no_text=='yes'){ echo '<span style="text-decoration:underline;">Yes</span>'; }else{ echo 'Yes'; } ?>
		<?php }else{ ?>
		Yes
		<?php } ?>
		&nbsp;or&nbsp; 
		<?php if($student->fathername!=''){ ?>
			<?php if($student->father_contact_no_text=='no' || $student->father_contact_no_text==''){ echo '<span style="text-decoration:underline;">No</span>'; }else{ echo 'No'; } ?>
		<?php }elseif($student->step_father_name!=''){ ?>
			<?php if($student->step_father_contact_no_text=='no' || $student->step_father_contact_no_text==''){ echo '<span style="text-decoration:underline;">No</span>'; }else{ echo 'No'; } ?>
		<?php }else{ ?>
		No
		<?php } ?>
		)</td><td colspan="2" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; font-size:12px; padding:0px 4px; margin:0px;" valign="top">Would you like to receive text messages about upcoming events, activities and other school announcements on this number?&nbsp;&nbsp;&nbsp;(
		
		<?php if($student->mothername!=''){ ?>
			<?php if($student->mother_contact_no_text=='yes'){ echo '<span style="text-decoration:underline;">Yes</span>'; }else{ echo 'Yes'; } ?>
		<?php }elseif($student->step_mother_name!=''){ ?>
			<?php if($student->step_mother_contact_no_text=='yes'){ echo '<span style="text-decoration:underline;">Yes</span>'; }else{ echo 'Yes'; } ?>
		<?php }else{ ?>
		Yes
		<?php } ?>

		&nbsp;or&nbsp;
		
		<?php if($student->mothername!=''){ ?>
			<?php if($student->mother_contact_no_text=='no' || $student->mother_contact_no_text==''){ echo '<span style="text-decoration:underline;">No</span>'; }else{ echo 'No'; } ?>
		<?php }elseif($student->step_mother_name!=''){ ?>
			<?php if($student->step_mother_contact_no_text=='no' || $student->step_mother_contact_no_text==''){ echo '<span style="text-decoration:underline;">No</span>'; }else{ echo 'No'; } ?>
		<?php }else{ ?>
		No
		<?php } ?>
		
		)</td></tr>
		<tr><td colspan="4" style="border-right:1px solid #8D38C9; border-left:1px solid #8D38C9; padding:4px 4px 2px 4px; margin:0px; font-weight:bold; font-size:16px;">LEGAL GUARDIAN INFORMATION</td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:425px;">&nbsp;<?=ucwords(strtolower($student->guardian_name));?><?=$student->guardian_mname!=''?' '.ucwords(strtolower($student->guardian_mname)):'';?> <?=ucwords(strtolower($student->guardian_lname));?></td><td style="width:30px;">&nbsp;</td></tr></table></td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">&nbsp;&nbsp;&nbsp;Citizenship(Passport):</td><td style="font-size:12px; border-bottom:1px solid #000; width:320px;">&nbsp;<?=$student->guardian_citizenship;?></td><td style="width:30px;">&nbsp;</td></tr></table></td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Philippine Visa Status:</td><td style="font-size:12px; border-bottom:1px solid #000; width:320px;">&nbsp;<?=$student->guardian_visa;?></td><td style="width:30px;">&nbsp;</td></tr></table></td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">&nbsp;&nbsp;&nbsp;Employer or Organization:</td><td style="font-size:12px; border-bottom:1px solid #000; width:290px;">&nbsp;<?=$student->guardian_occup;?></td><td style="width:30px;">&nbsp;</td></tr></table></td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Office Phone Number:</td><td style="font-size:12px; border-bottom:1px solid #000; width:320px;">&nbsp;<?=$student->guardian_office_tel;?></td><td style="width:30px;">&nbsp;</td></tr></table></td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">&nbsp;&nbsp;&nbsp;Mobile Number:</td><td style="font-size:12px; border-bottom:1px solid #000; width:350px;">&nbsp;<?=$student->guardian_contact_no;?></td><td style="width:30px;">&nbsp;</td></tr></table></td></tr>
		<tr><td colspan="4" valign="top" style="border-right:1px solid #8D38C9; border-left:1px solid #8D38C9; font-size:12px; padding:0px 4px; margin:0px;">Would you like to receive text messages about upcoming events, activities and other school announcements on this number?&nbsp;&nbsp;&nbsp;(
			<?php if($student->guardian_contact_no_text=='yes'){ echo '<span style="text-decoration:underline;">Yes</span>'; }else{ echo 'Yes'; } ?>
		&nbsp;or&nbsp; 
			<?php if($student->guardian_contact_no_text=='no' || $student->father_contact_no_text==''){ echo '<span style="text-decoration:underline;">No</span>'; }else{ echo 'No'; } ?>
		)</td></tr>
<!--
		<tr><td colspan="4" style="border-right:1px solid #8D38C9; border-left:1px solid #8D38C9; padding:4px 4px 2px 4px; margin:0px; font-weight:bold; font-size:16px;">EMERGENCY CONTACT INFORMATION</td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Name:</td><td style="font-size:12px; border-bottom:1px solid #000; width:425px;">&nbsp;<?=$student->emergency_name;?></td><td style="width:30px;">&nbsp;</td></tr></table></td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">&nbsp;&nbsp;&nbsp;Address:</td><td style="font-size:12px; border-bottom:1px solid #000; width:410px;">&nbsp;<?=$student->emergency_address;?></td><td style="width:30px;">&nbsp;</td></tr></table></td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">Office Phone:</td><td style="font-size:12px; border-bottom:1px solid #000; width:385px;">&nbsp;<?=$student->emergency_office_tel;?></td><td style="width:30px;">&nbsp;</td></tr></table></td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0"><tr><td style="font-size:14px;">&nbsp;&nbsp;&nbsp;Home Phone:</td><td style="font-size:12px; border-bottom:1px solid #000; width:380px;">&nbsp;<?=$student->emergency_home_tel;?></td><td style="width:30px;">&nbsp;</td></tr></table></td></tr>
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table><tr><td style="font-size:14px;">Mobile No.:</td><td style="font-size:12px; border-bottom:1px solid #000; width:400px;">&nbsp;<?=$student->emergency_home_no;?></td><td style="width:30px;">&nbsp;</td></tr></table></td><td colspan="2" style="border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">&nbsp;</td></tr>
-->
		<tr><td colspan="2" style="border-left:1px solid #8D38C9; border-bottom:1px solid #8D38C9; padding:2px 4px; margin:0px;">&nbsp;</td><td colspan="2" style="border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; padding:2px 4px; margin:0px;">&nbsp;</td></tr>
		<tr><td colspan="4" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:0px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td valign="top" ><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="width:14px; border:1 solid #000; text-align:center;">X</td></tr></table></td><td valign="top"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:13px;">Failure to provide complete and accurate information of any kind on this form will void the application and may result to its cancellation. <span style="font-size:14px;">WESTFIELDS INTERNATIONAL SCHOOL</span> reserves the right to determine the placement of the application in the grade level or subjects deemed most appropriate fo the student's school experience / performance.</td></tr></table></td></tr></table></td></tr>
		<tr><td colspan="4" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td valign="top"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td align="top" style="width:14px; border:1 solid #000; text-align:center;">X</td></tr></table></td><td valign="top" ><table style="font-size:13px;"><tr><td style="font-size:13px;">To the best of my knowledge the information written on this form is true and correct.</td></td></table></td></tr></table></td></tr>
		<tr><td colspan="4" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; padding:2px 4px; margin:0px;">&nbsp;</td></tr>
		<tr><td colspan="4" style="border-left:1px solid #8D38C9; border-right:1px solid #8D38C9; border-bottom:1px solid #8D38C9; padding:2px 4px; margin:0px;"><table cellPadding="0" cellSpacing="0" style="padding:0px; margin:0px;"><tr><td style="font-size:14px; text-align:center; width:300px; border-top:#000 1px solid;">Signature of Father</td><td style="width:30px;">&nbsp;</td><td style="font-size:14px; text-align:center; text-align:center; width:300px; border-top:#000 1px solid;">Signature of Mother</td><td style="width:30px;">&nbsp;</td><td style="font-size:14px; text-align:center; text-align:center; width:250px; border-top:#000 1px solid;">Date</td><td style="width:30px;">&nbsp;</td></tr></table></td></tr>
	</table>
</div>

<table cellPadding="0" cellSpacing="0" style="margin:0px; padding:0px; border-collapse:collapse; page-break-inside:avoid;">
<tr>
<td>

<div>
	<table cellPadding="0" cellSpacing="0" style="width:100%; border-collapse:collapse; page-break-inside:avoid;">
		<tr style="background-color:#8D38C9; margin:0px; padding:0px;">
			<td style="color:#FFFF00; font-size:16; padding:4; margin:0px; font-weight:bold;">MEDICAL INFORMATION and HEALTH HISTORY</td>
		</tr>
		<tr><td>&nbsp;</td></tr>
		<tr>
			<td><table cellPadding="0" cellSpacing="2" style="page-break-inside:avoid;"><tr><td>1.&nbsp;</td><td>Does your child have any of the following?</td></tr></table></td>
		</tr>
		<tr>
			<td><table cellPadding="0" cellSpacing="2" style="page-break-inside:avoid;">
			<tr><td style="width:50px;">&nbsp;</td><td>Allergies&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->hhc_allergies_reaction==''): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;No</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->hhc_allergies_reaction!=''): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;Yes</td><td style="width:50px;">&nbsp;</td><td>Reaction:</td><td style="border-bottom:1 solid #000; width:500px;">&nbsp;<?=$student->hhc_allergies_reaction;?></td></tr>
			<tr><td style="width:50px;">&nbsp;</td><td>Drug Allergies&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->hhc_alergic_med_reaction==''): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;No</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->hhc_alergic_med_reaction!=''): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;Yes</td><td style="width:50px;">&nbsp;</td><td>Reaction:</td><td style="border-bottom:1 solid #000; width:500px;">&nbsp;<?=$student->hhc_alergic_med_reaction;?></td></tr>
			<tr><td style="width:50px;">&nbsp;</td><td>Asthma&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->hhc_asthma=='no'): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;No</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->hhc_asthma=='yes'): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;Yes</td><td style="width:50px;">&nbsp;</td><td colspan="2"><table cellPadding="0" cellSpacing="0" style="page-break-inside:avoid;">
			<tr><td>Does your child carry an asthma inhaler?</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->hhc_asthma_inhaler=='no'): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;No</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->hhc_asthma_inhaler=='yes'): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;Yes</td></tr></table></td></tr>
			<tr><td style="width:50px;">&nbsp;</td><td>Eye or vision problems&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->dhc_sight_problems_what==''): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;No</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->dhc_sight_problems_what!=''): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;Yes</td><td style="width:50px;">&nbsp;</td><td>Describe:</td><td style="border-bottom:1 solid #000; width:500px;">&nbsp;<?=$student->dhc_sight_problems_what;?></td></tr>
			<tr><td style="width:50px;">&nbsp;</td><td>Ear or hearing problem(s)&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->dhc_hearing_problems_what==''): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;No</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->dhc_hearing_problems_what!=''): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;Yes</td><td style="width:50px;">&nbsp;</td><td>Describe:</td><td style="border-bottom:1 solid #000; width:500px;">&nbsp;<?=$student->dhc_hearing_problems_what;?></td></tr>
			</table></td>
		</tr>
		<tr>
			<td><table cellPadding="0" cellSpacing="2" style="page-break-inside:avoid;"><tr><td>2.&nbsp;</td><td>Any other health condition that the school should be aware of (e.g. epilepsy, diabetes etc):</td><td style="border-bottom:1 solid #000; width:410px;">&nbsp;<?=$student->hhc_diagnosed_specify;?></td></tr></table></td>
		</tr>
		<tr>
			<td><table cellPadding="0" cellSpacing="2" style="page-break-inside:avoid;"><tr><td>3.&nbsp;</td><td>Has your child recently been hospitalized? Why? / When?&nbsp;</td><td style="border-bottom:1 solid #000; width:600px;">&nbsp;<?=$student->hhc_recently_hospitalized;?></td></tr></table></td>
		</tr>
		<tr>
			<td><table cellPadding="0" cellSpacing="2" style="page-break-inside:avoid;"><tr><td>4.&nbsp;</td><td>Has your child recently had any serious injuries: Why? / When?&nbsp;</td><td style="border-bottom:1 solid #000; width:580px;">&nbsp;<?=$student->hhc_major_injury_specify;?></td></tr></table></td>
		</tr>
		<tr>
			<td><table cellPadding="0" cellSpacing="2" style="page-break-inside:avoid;"><tr><td>5.&nbsp;</td><td style="width:210px;">Is your child on a regular medication?&nbsp;<td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->hhc_medication_school_hours==''){ ?>X<?php }else{ ?>&nbsp;<?php } ?></td><td>&nbsp;&nbsp;No</td><td style="width:20px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->hhc_medication_school_hours==''){ ?>&nbsp;<?php }else{ ?>X<?php } ?></td><td>&nbsp;&nbsp;Yes.&nbsp;</td><td>Name of medication(s) and frequency:</td><td style="border-bottom:1 solid #000; width:400px;">&nbsp;<?=$student->hhc_medication_school_hours;?></td></tr></table></td>
		</tr>
		<tr>
			<td><table cellPadding="0" cellSpacing="2" style="page-break-inside:avoid;"><tr><td>6.&nbsp;</td><td style="width:400px;">Does your child need to take any medication/s during school hours?&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->hhc_medication_school_hours=='no'){ ?>X<?php }else{ ?>&nbsp;<?php } ?></td><td>&nbsp;&nbsp;No</td><td style="width:20px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->hhc_medication_school_hours=='yes'){ ?>X<?php }else{ ?>&nbsp;<?php } ?></td><td>&nbsp;&nbsp;Yes&nbsp;</td><td>(If so, a letter from the Medical Doctor must be submitted, and be kept on file and&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td></tr><tr><td>&nbsp;</td><td colspan="7">medication(s) will also be kept in the school, to be dispensed only by the teacher or authorized person.)</td></tr></table></td>
		</tr>
		<tr><td>&nbsp;</td></tr>
	</table>

</div>

<div>
	<table cellPadding="0" cellSpacing="2" style="margin:0px; padding:0px; border-collapse:collapse; page-break-inside:avoid;">
		<tr style="background-color:#8D38C9; margin:0px; padding:0px;">
			<td style="color:#FFFF00; font-size:16; padding:4; margin:0px; font-weight:bold; text-align:center;">AUTHORIZATION</td>
		</tr>
		<tr><td>&nbsp;</td></tr>
		<tr>
			<td>I give consent for my child to receive the following:</td>
		</tr>
		<tr>
			<td><table cellPadding="0" cellSpacing="2">
			<tr><td style="width:50px; margin:2px 0px; padding:0px;">&nbsp;</td><td>*1. Minor first aid&nbsp;</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->auth_firstaid=='yes'): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;Yes</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->auth_firstaid=='no'): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;No</td></tr>
			<tr><td style="width:50px;">&nbsp;</td><td>*2. Emergency care&nbsp;</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->auth_emergency_care=='yes'): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;Yes</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->auth_emergency_care=='no'): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;No</td></tr>
			</table></td>
		</tr>
		<tr>
			<td><table cellPadding="0" cellSpacing="2">
			<tr><td style="width:50px; margin:2px 0px; padding:0px;">&nbsp;</td><td>*3. Emergency care at the nearest hospital&nbsp;</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->auth_emergency_care_hospital=='yes'): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;Yes</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->auth_emergency_care_hospital=='no'): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;No</td></tr>
			<tr><td style="width:50px;">&nbsp;</td><td>*4. Oral non-presciption medication&nbsp;</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->auth_oral_non_presc=='yes'): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;Yes</td><td style="width:50px;">&nbsp;</td><td style="width:14px; border:1 solid #000; text-align:center;"><?php if($student->auth_oral_non_presc=='no'): ?>X<?php else: ?>&nbsp;<?php endif; ?></td><td>&nbsp;No</td></tr>
			</table></td>
		</tr>
		<tr><td>&nbsp;</td></tr>
		<tr><td><table cellPadding="0" cellSpacing="0"><tr><td valign="top" style="font-size:14px;">***NOTE:</td><td style="width:20px; margin:0px; padding:0px;">&nbsp;</td><td>If you answered "NO" to numbers 1, 2, and / or 3, you must provide the school with alternative emergency care instructions, to be kept in your child's school records / file.</td></tr></table></td></tr>
		<tr><td>&nbsp;</td></tr>
		<tr><td style="font-style:italic;">Permission is hereby given for emergency measures to be initiated in case of accident or sudden illness with the undestanding that I will be notified as soon as possible.</td></tr>
		<tr><td>&nbsp;</td></tr>
		<tr><td style="font-style:italic;">I certify that all information given is complete and correct.</td></tr>
		<tr><td>&nbsp;</td></tr>
		<tr><td style="font-style:italic;">I acknowledge that it is my responsibilty to inform Westfields IS of any changes in my child's health, physical condition or medical needs and any changes in our address and / or contact number(s).</td></tr>
		<tr><td>&nbsp;</td></tr>
		<tr><td>&nbsp;</td></tr>
		<tr><td><table><tr><td>Parent's Signature</td><td style="width:250px; border-bottom:#000 1px solid;">&nbsp;</td><td style="width:300px;">&nbsp;</td><td>Date:</td><td style="width:250px; border-bottom:#000 1px solid;">&nbsp;</td></tr></table></td></tr>
	</table>
</div>

</td>
</tr>
</table>